EEGs

Question 1

For a sharp wave to be apparent, at least

___ cm2 of cortex needs to be involved

Answer 1

6cm2

Question 2

The parasomnias associated with slow wave sleep are? (3)

Answer 2

sleep walking, night terrors, bedwetting

Question 3

Frontal lobe seizures are typically nocturnal and arise from what stage of sleep?

Answer 3

stage II

Question 4

What is Mu rhythm?

Answer 4

is normal, and found in the central derivations (C3/C4) over the motor strip. Can be bilateral or unilateral. Attenuates with movement or even the thought of movement.

Question 5

Wicket spikes are found in which electrodes?

Answer 5

Mid-temporal electrodes

Question 6

Normal response to hyperventilation on EEG?

Answer 6

High voltage theta activity (children are more likely to achieve this than adults)

Question 7

What is a photomyogenic response? How is this different from photic driving?

Answer 7

EEG artifact in the frontal derivations time locked to the flash frequency.

Photic driving:
Photic stimulation can evoke a rhythmic frequency in the occipital derivations which is at same frequency (the fundamental), a harmonic (twice the flash frequency) and/or a subharmonic (half the flash frequency).

Question 8

in a normal infact, sleep spindles typically develop at what age?

Answer 8

1.5 - 3months

Question 9

Why are sleep spindles not synchronous in infants?

Answer 9

due to lack of myelination in the neonatal brain. By 2 years of age, it is considered abnormal if most spindles are still asynchronous.

Question 10

Majority of children will have a PDR of 8Hz by what age?

Answer 10

36 months

Question 11

What are BIRDs?

Answer 11

brief potentially ictal rhythmic discharge (BIRD) in the alpha and theta range. BIRDs are very brief (less than 10 seconds, typically 0.5–4 seconds) runs of rhythmic activity greater than 4Hz without evolution. They can be lateralized or generalized and are highly correlated with the seizure focus.

Question 12

what seizure aura can be mistaken for panic attacks?

Answer 12

Very brief, in the order of seconds, sensations of fear are a common aura of a mesial temporal lobe seizure and can be mistaken for panic attacks.

Question 13

What is Panayiotopolous syndrome?

Answer 13

children present with rare prolonged nocturnal seizures with autonomic features and eye deviation.

Question 14

A strong sensation of being pursued by a predator who is behind and on the left is most consistent with a seizure from the

Answer 14

the ipsilateral amygdala

Question 15

The triad of West syndrome is….

Answer 15

infantile spasms, hypsarrythmia, and developmental delay and/or regression

Question 16

Treatment of hypsarrhythmia?

Answer 16

ACTH

Question 17

Leucine-rich, glioma inactivated 1 (LGI1) gene.

Answer 17

Autosomal dominant partial epilepsy with auditory features

Question 18

Heat sensitive seizures, hemi-convulsions, myoclonic seizure, atypical absence, ataxia, and neurological regression.

Answer 18

Dravet syndrome

Question 19

Hypsarrhythmia, infantile spasms, developmental regression and delay.

Answer 19

West syndrome

Question 20

Occipitally predominant generalized rhythmic delta activity (aka OIRDA-occipital intermittent rhythmic delta activity).

Answer 20

childhood absence epilepsy

Question 21

Myoclonic jerks, absence seizures, generalized tonic clonic convulsion

Answer 21

JME

Question 22

Language regression, electrical status epilepticus in sleep.

Answer 22

Landau–Kleffner syndrome

Question 23

Tonic seizures, burst suppression, abnormal CT head.

Answer 23

Ohtahara syndrome

Question 24

Slow spike and wave, multiple seizure types, cognitive impairment.

Answer 24

Lennox–Gastaut syndrome

Question 25

he EEG shows continuous 1–2 Hz generalized periodic discharges often with a triphasic morphology and sometimes with an anterior to posterior lag (box shows a wave with an A-P lag). This is most consistent with

Answer 25

toxic metabolic encephalopathy

Question 26

LPDs are most commonly associated with

Answer 26

cute, structural lesion involving the cortex. Therefore, other findings of focal dysfunction such as focal slowing or attenuation are frequently accompanied in the ipsilateral hemisphere. The most common etiology of LPDs is an ischemic stroke. Other frequent etiologies include viral encephalitis, brain tumors, brain abscesses and intracranial hemorrhages.

Question 27

MRI shows diffusion restriction in the caudate and in the putamen as well as hyperintense signal in the cortex (cortical ribboning). The EEG shows generalized periodic sharp waves at 1–2 Hz that are either biphasic or triphasic (GPDs) on a suppressed background. What is the diagnosis?

Answer 27

CJD